Purpose: Although hepatectomy is an established curative treatment for hepatocellular carcinoma (HCC), early recurrence is common. We defined recurrence within 6 months after hepatectomy as early recurrent HCC. The aim of this retrospective study was to evaluate the features and predictive factors of early recurrent HCC after hepatectomy. Method: We enrolled 93 patients who underwent hepatectomy as initial treatment for HCC from January 2005 to June 2012. These patients were divided into two groups. Twelve (12.9%) were in the early recurrence group (ERG) and, 81 (87.1%) were in the non-early recurrence group (NERG). We compared these groups clinicopathologically. Results: The median time to recurrence in the ERG was 3.5 months (1–5 months), and the median overall survival was 13 months. The 3-year survival rates were 30.6% and 90.8% in the ERG and NERG, respectively (P<0.001). According to a multivariate analysis, the only factor predicting early recurrence was the tumor stage (P=0.008), and the cut-off was stage III disease. We compared patients in the ERG and NERG within stage III and IVa HCC. In multivariate analysis, there were no significant differences between the groups, but in univariate analysis, an AFP ≥43 ng/ml (P=0.004) and the presence of a capsule defect (P=0.004) were factors predicting early recurrence. Conclusion: Patients with stage III or stage IVa HCC, an AFP value ≥43 ng/ml and capsule defect are likely to have early recurrence and a poor prognosis after hepatectomy.

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A 63-year-old man underwent distal pancreatectomy for intraductal papillary mucinous neoplasm (IPMN) 2 years previously and was being followed-up. Although the patient had no specific symptoms, a submucosal tumor 2 cm in diameter was detected on upper gastrointestinal endoscopy in the middle portion of the gastric corpus during a health checkup. A detailed examination could not completely rule out the likelihood of the tumor being associated with malignant disease. Thus, partial gastric resection was performed. Histopathological examination of the resected specimen revealed no tumor in the gastric mucosa, but a highly well-differentiated intestinal type adenocarcinoma was confirmed in the part of the mucosa between the fundic gland and the pyloric gland. The tumor showed cystic dilatation distributed in the submucosal layer of a hamartomatous inverted polyp (HIP). Thirty-one cases of HIP have been reported in Japan, including this case. Of these, concomitant gastric cancer was confirmed in 4 cases including this one, but cancer in the mucosa showing cystic dilatation was seen only in our case. Treatment strategies need to be decided after considering the possibility of malignant disease in cystic lesions in the submucosal layer of an HIP.

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A 71-year-old man underwent pancreaticoduodenectomy (II region) for a pancreatic neuroendocrine tumor (PNET). He was periodically followed-up at an outpatient clinic. Six years after surgery, contrast-enhanced abdominal CT revealed a tumorous lesion, measuring 20 mm, with an unclear border and enhancement effects on the S4 liver surface. MRI with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA-enhanced MRI) also showed a low-signal-intensity area at the same site in the hepatocellular phase. Under a tentative diagnosis of primary liver cancer or metastatic liver tumor from PNET, partial hepatectomy (S4) was conducted. In the resected specimen, a white, irregular mass with a clear border was observed. Histopathological findings included marked fibrous thickening of the bile duct wall and the infiltration of inflammatory cells, leading to a diagnosis of sclerosing cholangitis. His medical history suggested secondary sclerosing cholangitis after biliary-tract reconstruction. To the best of our knowledge, there have been no case reports published on secondary sclerosing cholangitis localized in the peripheral intrahepatic bile duct. Although a preoperative diagnosis is difficult, resection should be considered if the possibility of malignant tumors cannot be ruled out.

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The groove area is located between the head of the pancreas, the duodenum, and the common bile duct. Differentiating groove pancreatitis from pancreatic carcinoma is often difficult. We report a case of a 77-year-old man with groove pancreatic adenocarcinoma accompanied by vomiting. The diagnosis was confirmed by dynamic contrast-enhanced computed tomography (Dynamic CT), gastrointestinal endoscope (GIF), and colon fiber (CF). We suspected groove pancreatic carcinomas rather than groove pancreatitis because the mass invaded the colon as well as the duodenum. The patient underwent pancreatoduodenectomy. Pathological findings revealed invasive ductal carcinoma, moderately differentiated tubular adenocarcinoma, int, INFb, ly1, v0, pT4 [CH (–), DU (+), S/RP (+), PV (–), A (–), PL (–), OO (+: transverse colon)], pN1, M0, pStage IVa, pPCM (–), pBCM (–), pDPM (–), according to the General Rules for the Study of Pancreatic Cancer (6th Edition).

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We report a case of retroperitoneal enteric duplication cyst (REDC) in an adult. A 46-year-old-woman was referred to our hospital. Enhanced CT showed a retroperitoneal cystic mass 4.6 cm in diameter. Endoscopic ultrasound (EUS) showed a cystic mass with a thick and multi-layered wall. It grew to 5.7 cm in diameter after 18 months later. Then tumor extirpation under laparotomy was performed. The cystic mass, located adjacent to the pancreatic head, did not communicate with any gastrointestinal tract and mesentery. Its wall had thick muscular layers lined with inner layers mimicking gastrointestinal mucosa. On histological examination, the diagnosis was an enteric duplication cyst. REDC that has neither communication nor common mesentery with gastrointestinal tracts is extremely rare. We should consider REDC when a retroperitoneal cystic mass with thick and layered wall is found by ultrasound (US).

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We report on a rare case of esophageal hitus hernia after laparoscopic total gastrectomy (LTG). A 73-year-old man underwent LTG with D2 lymph node dissection and Roux-en-Y (overlap) reconstruction for early gastric cancer. After one year, he was admitted to our hospital with acute abdominal pain. Abdominal CT scan revealed a dilated small intestine prolapsing into the thoracic cavity through the left side of the esophageal hiatus and ischemia of the prolapsed small intestine. He underwent emergency operation based on a diagnosis of strangulation ileus caused by esophageal hiatal hernia. We successfully reduced the prolapsed small intestine back to the abdominal cavity. There was no necrosis in the area. The hernia orifice was occluded by suturing posterior walls of the diaphragm crus and the esophagus was securely fixed by 4 sutures to the diaphragm crus.

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